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California Hazardous Materials Inventory Reporting Form - Chemical Description Pa e <br /> (1) DD❑ DELETE OREVISE 20040 PAGE(2) OF (3) <br /> 1SINESS NAME (4) 99 Shell 7524-4180 <br /> CHEMICAL LOCATION (5) <br /> MAP#(6) / GRID#(7) <br /> CHEMICAL NAME (8) GLYCOLS TRADE SECRE r 01) ❑Y ON <br /> COMMON NAME (9) ANTIFREEZEICOOLAN I EHS(12) ❑y ON <br /> IF EHS BOX IS"Y" <br /> CAS# (1 o) 107-21-1 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE LEAVE BLANK <br /> HAZARD CLASSES (13) <br /> TYPE (14) ❑PURE 4MIXTURE ❑WASTE RADIOACTIVE(ls) ❑Y ON (16) <br /> PHYSICAL STATE (17) ❑ SOLID gLIQUID ❑ GAS CURIES <br /> FED HAZARD 'FIRE ❑ REACTIVE ❑ PRESSURE RELEASE ACUTE HEALTH I rCHRONIC HEALTH <br /> CATEGORIES (1 s) <br /> STATE WASTE (19) UNITS(22) Q GAL [ICU FT MAX DAILY AMT(23) 15 <br /> CODE ❑ LBS ❑TONS <br /> DAY„iN SITE (20) 365 If EHS,amounts must be in Ib. AVG DAILY AMT(24) 10 <br /> 1, SEST (21) 1 ANNUAL WASTE ANIT(25) <br /> C_,. TAINER <br /> STORAGE ('-b) ❑ABOVE GROUND"TANK ❑CAN ❑BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ❑CYLINDER ❑RAIL CAR <br /> 14 ❑TANK INSIDE BUILDING ❑SILO ❑GLASS BOTTLE ❑BATTERY CELL <br /> ❑STEEL DRUM ❑FIBER DRUM CLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC-DRUM ❑BAG ❑TOTE BIN <br /> STORAGE (27) AMBIENT 11ABOVE AMBIENT ❑ BELOW AMBIEty,T <br /> STORAGE (Y1) 2x AMBIENT ❑ ABOVE AMBIENT ❑BELOW ALIB1ENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (3o)HAZARDOUS COMPONENTS (31)EHS (32)CAS# <br /> 94% ETHYLENE GLYCOL t ❑Y ON 107-21-1 <br /> 2-5% DEIONIZED WATER ❑Y ON 7732-18-5 <br /> 1-3% DIPOTASSIUM PHOSPHATE ❑Y ON 7758-114 <br /> ❑Y ON <br /> ❑Y ON <br /> WCWONAT LOCALLY COLLECTED INFORMATION 33)UNITED NAT[ONS m#(DOT) 1142 <br /> (34)UHADT ISOTRHE MATERIAL COOLANT <br />